Significant Reduction In A1C Research Articles

Real-world evaluation of the effects of tirzepatide in patients with type 2 diabetes mellitus.

Tirzepatide is a first-in-class combination glucose-dependent insulinotropic polypeptide (GIP) receptor agonist and glucagon-like peptide 1 receptor agonist (GLP1-RA) approved for treatment of adults with type 2 diabetes mellitus (T2DM) and chronic weight management. The aim of this analysis was to assess the real-world efficacy of tirzepatide in patients with T2DM. This retrospective observational study evaluated patients with T2DM from a large urban academic medical centre who received at least 3 months of continuous tirzepatide treatment. The primary outcome was change in A1C from following tirzepatide treatment. Secondary outcomes included change in body weight and body mass index (BMI) after tirzepatide was initiated. A total of 1896 patient charts were reviewed, and 612 patients were evaluated for the primary outcome. Over a median time period of 10.4 months, treatment with tirzepatide resulted in a mean A1C reduction of 1.02 ± 1.48% (p < 0.001). A total of 570 patients were evaluated for the secondary outcomes. Tirzepatide was associated with a mean reduction in body weight of 7.3 ± 9.3 kg (p < 0.001) and a mean reduction in BMI of 2.5 kg/m2. Greater A1C lowering and weight loss was observed in patients without prior GLP1-RA treatment compared to those switched to tirzepatide from GLP1-RA. In a real-world population of US patients with T2DM, tirzepatide was associated with clinically and statistically significant reductions in A1C and body weight. Greater reductions in both A1C and body weight were observed among patients who were GLP1-RA naïve compared to patients switched from GLP1-RA to tirzepatide.

Unveiling contrasts in microbiota response: A1c control improves dysbiosis in low-A1c T2DM, but fails in high-A1c cases—a key to metabolic memory?

IntroductionType 2 diabetes mellitus (T2DM) is associated with dysbiosis in the gut microbiota (MB). Individually, each medication appears to partially correct this. However, there are no studies on the response...

Evaluation of a pharmacist-led personal continuous glucose monitor workflow to improve glycemic management in an internal medicine clinic

BackgroundThe use of personal continuous glucose monitors (CGMs) in patients with diabetes has increased substantially and is expected to continue to increase as CGMs become more affordable and insurance plans improve coverage. The utilization of CGMs has improved diabetes management and reduced hypoglycemic events. ObjectivesTo create pharmacist-led personal CGM workflow and evaluate its impact on glycemic management in patients with diabetes. Practice DescriptionThe study took place at an Internal Medicine Clinic. The practice providers include 2 medical doctors, 5 physician assistants, 2 nurse practitioners, and 1 clinical pharmacist. Practice InnovationTo create and implement a sustainable pharmacy led CGM workflow for enhanced CGM use within an internal medicine clinic. Evaluation MethodsThis was a prospective, investigator-initiated pilot study conducted at an Atrium Health Internal Medicine clinic over 28 weeks. In this pilot, 42 patients were qualifying candidates with diabetes and personal CGM use. In addition, 30 patients were followed until study completion and included into final analysis. ResultsThe average baseline A1c was reduced from 8.3% to 7.1% over a 3- to 6-month period. The pharmacist-led CGM workflow revealed a statistically significant reduction in A1c from baseline by an average of 1.2% (95% CI −0.6 to −1.8, P = 0.0006). On average, patients were enrolled for 19.9 weeks and had an average of 5 visits during this time. During the study duration, 100 medications changes were implemented under the existing clinical pharmacist practitioner agreement between the pharmacists and the provider. Overall, 58 Current Procedural Terminology 95251 codes were billed yielding $7052.00 in billed CGM services for the clinic. This project generated 40.6 provider relative value units. ConclusionThe utilization of a pharmacist-led personal CGM workflow can improve diabetes outcomes.

Impact of Risk Stratification in Patients With Diabetes Mellitus in a Health System Specialty Pharmacy Setting

Background: Integrated pharmacist care into health systems results in significant A1c reduction and improved outcomes in patients with diabetes. However, little is known about the adoption of Health System Specialty Pharmacy (HSSP) chronic disease management (CDM) services within diabetes clinics. Risk stratification is proven to enhance care in various patient populations. Objective: The objective of this study is to describe how the implementation of risk stratification in the HSSP setting results in optimized patient outcomes in diabetes. Method: This is a retrospective descriptive study reporting the results of expanding the HSSP care model to implement risk stratified CDM services for patients with diabetes. A total of 285 patients were enrolled in the HSSP CDM pharmacy services and were stratified into high- or low-risk groups. Results: Eighty-eight patients were stratified as high-risk with an average baseline A1c of 11.47% and a most recent average of 8.84%. The remaining 285 patients were stratified into the low-risk group. Their average baseline A1c was 7.48% and the last recorded average A1c was 7.15%. Patients not enrolled in HSSP CDM services (N = 100) had a lower reduction in average A1c compared to patients enrolled in the program. Conclusion: Patients stratified into high- and low-risk groups had greater reductions in A1c compared to patients who did not use HSSP CDM services. These results showcase the success of risk stratification and demonstrate the impact HSSP has on patients needing CDM services and outlines a strategy to provide the greatest impact in a high-volume patient population.

Long-Term Results of a Digital Diabetes Self-Management and Education Support Program Among Adults With Type 2 Diabetes: A Retrospective Cohort Study.

The purpose of this study is to examine the long-term impact of a digital diabetes self-management education and support (DSMES) program on A1C among adults with type 2 diabetes (T2DM). Data analyzed were from a retrospective cohort of commercially insured members with T2DM enrolled in the Omada for Diabetes program between January 1, 2019, and January 31, 2022 (n = 1,322). Linear mixed models measured changes in A1C and weight across 12 months (collected at baseline and every 3 months over 1 year) overall and stratified by A1C at baseline (≥8% vs <8%). On average, members were 53.5 years old, 56.9% female, and 71.5% White, with a mean baseline body mass index (BMI) of 36.9 and A1C of 7.6%. Members with baseline A1C ≥8% demonstrated clinically and statistically significant adjusted mean reductions in A1C during follow-up, from 9.48% at baseline to 7.33%, 7.57%, 7.59%, and 7.47% at 3, 6, 9, and 12 months, respectively. Those with A1C <8% maintained glycemic stability (6.73%, 6.50%, 6.54%, 6.62%, and 6.51%, respectively). Collectively, members experienced a -1.17 kg/m2 mean reduction in BMI over 12 months. This study provides real-world evidence that members with elevated baseline A1C (≥8%) enrolled in a digital DSMES program experienced clinically meaningful and statistically significant reductions in A1C. Those with baseline A1C within goal treatment range (<8%) maintained glycemic stability over 1 year. The findings support existing evidence that scalable digital DSMES solutions can help individuals with T2DM manage their condition.

Evaluating the Clinical Effect of Personal Continuous Glucose Monitoring in a Diverse Population With Type 2 Diabetes.

Objective: To determine the clinical effect of personal continuous glucose monitoring (CGM) in a diverse population with type 2 diabetes (T2D). Research Design and Methods: A report was created from the electronic health record identifying adults prescribed CGM at an urban family medicine clinic between January 1, 2019, and February 23, 2022. An "index date" was identified as the start of CGM. The closest hemoglobin A1c (A1c) 6 months or more after the index date was identified as the "follow-up date." The primary outcome of this study was to compare the percentage of individuals meeting the MN Community Measure (MNCM) D5 HbA1c goal of <8% at the follow-up date versus the index date. Results: Seventy-two patients were identified after the exclusion criteria were applied. Approximately one-third of patients required utilization of an interpreter and 76% of patients were of a racial or ethnic minority. The mean HbA1c prior to CGM use was 9.8%, with 16.7% of the population meeting the MNCM D5 A1c goal of <8%. At the follow-up date, the mean A1c was 8.4% (mean difference -1.4%; p < 0.001), with 41.7% of the population meeting goal (mean difference +25%; p < 0.001). Subgroup analyses affirm that the results of the primary outcome were sustained despite insulin use status. Conclusion: A diverse population with T2D had a significant reduction in A1c and was more likely to meet the MNCM D5 A1c goal of <8% after an average of 6 months using personal CGM.

1809-PUB: Painful Diabetic Neuropathy—Patients Treated with High-Frequency (10 kHz) Spinal Cord Stimulation (SCS) Experience Significant Reductions in A1C and Weight

Objective: Up to 9 million Americans have painful diabetic neuropathy (PDN), which can be debilitating. For PDN patients, 10 kHz SCS has been shown to provide mean pain relief of 77% at 24 months (24M), and here we report secondary, novel potential benefits for A1C and body weight. Methods: Subjects received a 10 kHz SCS implant plus medical management for their pain and diabetes. Subjects were followed for 24M post-implantation. Key inclusion criteria were: PDN ≥12M refractory to medications, lower limb pain ≥5cm (10cm VAS), and A1C ≤10%. For T2D subjects, changes in weight were evaluated for all subjects and cohorts with pre-implant BMI ≥30 and ≥35, and changes in A1C were evaluated for cohorts with pre-implant A1C ≥7.0% and ≥8.0%. Results: For cohorts evaluated, A1C and weight generally decreased with time (Fig. 1). For subjects with pre-implant A1C ≥8.0%, the mean A1C reduction was 0.52% at 6M (p=0.064) and 1.04% at 24M (p=0.007). For all subjects, the mean weight reduction was 1.8 kg at 12M (p=0.058) and 3.1 kg at 24M (p=0.003). For subjects with pre-implant BMI ≥35, the mean weight reduction was 5.4 kg at 24M (p=0.005). Conclusions: Previously reported pain relief and sensory improvement, coupled with reductions in A1C and weight reported here, further demonstrate the benefits of 10 kHz SCS treatment in the comprehensive care of T2D patients with PDN. Disclosure D.C.Klonoff: Consultant; EOFlow Co., Ltd., Fractyl Health, Inc., Integrity, Lifecare, Inc., Rockley Photonics, Thirdwayv Inc. B.L.Levy: Advisory Panel; Nevro Corp., CeQur SA, Consultant; Nevro Corp., CeQur SA, Digma Medical. M.Jaasma: Consultant; Bone Health Technologies, Inc., Employee; Nevro Corp., Bone Health Technologies, Inc. M.Bharara: Employee; Nevro Corp. C.E.Nasr: Advisory Panel; Siemens, Horizon Therapeutics plc. D.L.Caraway: Employee; Nevro Corp. E.Petersen: Consultant; Abbott, Biotronik, Medtronic, Nalu, Nevro Corp., Presidio Medical, Saluda Medical, Vertos Medical Inc., Research Support; Nalu, Nevro Corp. D.G.Armstrong: Research Support; Medaxis LLC. Funding Nevro Corp.

837-P: Improved Outcomes across Socioeconomically Advantaged and Disadvantaged Communities—A Real-World Study

Socioeconomic conditions of one's community have been attributed to disparities in diabetes outcomes and management practices. Among a random sample (n=19955) of people with type 2 diabetes receiving care at a nationwide telemedicine clinic utilizing a carbohydrate restricted nutritional approach and continuous remote care model (CR-CRCM), we explored A1c and medication utilization by area deprivation index quintile (Q). Upon enrollment, patients residing in more disadvantaged areas (Q4, Q5) had higher A1c compared to the least disadvantaged area (Q1; 7.8% vs 7.7%, p&amp;lt;0.01), and insulin (INS) and sulfonylureas (SU), but not other medication classes, were prescribed to a greater proportion of patients living in Q5 (25% INS, 23% SU) compared to Q1 (18% INS, 18% SU) and Q2 (21% INS, 19% SU) after accounting for differences in age, sex, baseline BMI, baseline INS use (when appropriate), and race and ethnicity (p&amp;lt;0.05). After one year in clinic, no differences in the prescription of medication classes between Q were observed, except for INS, where greater use remained only in Q5 than Q1 (14% vs 10%, p=0.011); among those remaining on INS, dose was reduced by 49-58% across all Q (p&amp;lt;0.001). Differences in SU use were no longer present; 77-83% fewer SU were prescribed across Q. Differences in A1c between Q4 (6.6%) and Q5 (6.7%) vs Q1 (6.5%) remained (p&amp;lt;0.001), though all groups achieved significant reductions in A1c of 1.1-1.2% (all p&amp;lt;0.001) concurrent with reduced prescription of all diabetes medication (from 1.7-1.8 to 1.1-1.2 medication classes per person). Across all levels of socioeconomic disadvantage, patients achieved clinically and statistically meaningful reductions in A1c and medication. Higher rates of SU use among patients residing in more disadvantaged areas were mitigated through a CR-CRCM to improve glycemia. Further, these data suggest a CR-CRCM may overcome financial barriers to optimal diabetes management through reduced need for medication. Disclosure A.L.Mckenzie: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. S.J.Athinarayanan: Employee; Virta Health Corp.

82-LB: Effectiveness of Coordinated and Centralized Care for Insulin Pump Users—A Multiple-Year Cohort Study

Background: With &amp;gt;13000 children diagnosed with type 1 diabetes each year, it imposes a tremendous burden on US healthcare. However, data are scarce on management models for pump users. Methods: In this observational cohort study, patients (pts) were systematically monitored for 4 years at our centralized &amp; coordinated pump center. Data on both outcome measures (percentage of glycated hemoglobin, or A1C) &amp; pt characteristics were routinely documented. Results: For all study pts (n=219), a statistically significant reduction in A1C was observed (-0.4% A1C; 95% CI: -0.7-0.1%). And this is true for all three groups of pts disaggregated by initial A1C (7.5-10, 8.0-10, ≥10). The reduction was -0.6 (95% CI: -0.8-0.3) for ps with a starting A1C between 7.5-10; -0.8 (95% CI: -1.1-0.5) for pts with a starting A1C of 8.0-10; and -2.4 (95% CI: -3.4 -1.3) for pts with a starting A1C above 10. A majority of pts reached their target A1C levels, and most of them achieved that in first quarter after the installation of insulin pumps (See Fig 1). Conclusions: Through centralized and coordinated care, a pump center is effective in assisting diabetes patients in properly using insulin pumps and quickly achieving their target A1C levels. Given the heavy burden of diabetes and large number of insulin pumps, the model of a pump center may be able to help confront the disease burden, and therefore needs to be made available to more patients. Disclosure K. Latif: Research Support; Medtronic, Senseonics. Board Member; Bigfoot Biomedical, Inc. Q. Li: None. Y. Shaikh: None. F. H. Cheema: None. A. Hyder: None.

Efficacy and Safety of Tirzepatide in Adults With Type 2 Diabetes: A Perspective for Primary Care Providers.

This article reviews the efficacy and safety data of tirzepatide, a once-weekly, novel glucose-dependent insulinotropic polypeptide and glucagon-like peptide 1 (GLP-1) receptor agonist approved in the United States, the European Union, and other regions for the treatment of type 2 diabetes. All doses of tirzepatide demonstrated superiority in reducing A1C and body weight from baseline versus placebo or active comparators. The safety profile of tirzepatide was consistent with that of the GLP-1 receptor agonist class, with mild to moderate and transient gastrointestinal side effects being the most common adverse events. With clinically and statistically significant reductions in A1C and body weight without increased risk of hypoglycemia in various populations, tirzepatide has demonstrated potential as a first-in-class treatment option for many people with type 2 diabetes.

ODP259 Evaluating the Efficacy and Safety of Long-Acting GLP-1 Receptor Agonist in T1DM Patients

Abstract Introduction GLP-1 receptor agonist is a medication class that mimics the endogenous incretin hormone GLP-1. Short-acting GLP-1 agents were studied as adjunct therapies in type 1 diabetes (T1DM) but not approved due to concern of increased diabetic ketoacidosis (DKA) risk. Long-acting GLP-1 medications are still commonly prescribed for T1DM patients. One study has assessed the impact of a long-acting GLP-1 in 11 T1DM patients. No hospitalizations were observed, and time in range was not reported. [1] Our study aims to evaluate the efficacy and safety of long-acting GLP-1 medications in a larger cohort of T1DM patients. Methodology We conducted a retrospective chart review of T1DM patients taking a long-acting GLP-1 for at least three months. ICD-10 code E10. Type 1 diabetes mellitus was used to search our institution's Electronic Health Record system (EPIC). Primary parameters collected included A1C and glycemic trends. Data analysis was done by averaging values over a two-year period before and after starting the medication. Results We identified 27 participants with T1DM (mean age 42yrs, mean T1DM duration 18.1yrs) on a long-acting GLP-1 (semaglutide 70.4%, dulaglutide 33.3%, long-acting exenatide 3.7%, albiglutide 3.7%). Mean therapy duration was 24.28±19. 01mo. A1C values decreased significantly from7.61±1. 08% to 7.16±0.73% (p=0. 015, N=25). Per CGM data, average time in range (TIR) increased significantly from48.82±22.35% to64.70±16.58% (p=0. 0002, N=15), average time in hyperglycemia decreased from42.39±23.32% to 31.58±16.65% (p=0. 019, N=14) and 14-day blood mean glucose decreased from 190.40±38.42 mg/dl to 167. 06±25.86 mg/dl (p=0. 001, N=17). There were no statistically significant differences in time in hypoglycemia and incidence of DKA. Hyperglycemic and hypoglycemic episodes were defined per patients’ individualized CGM settings (most commonly Blood Glucose levels&amp;gt;180 and &amp;lt;70 respectively). Patients’ weight decreased non-significantly from182. 00±50.92 lbs to 170.88±51.37 lbs (p=0.128, N=8). There were no ER visits or hospitalizations for DKA while on GLP-1 therapy. Conclusion There is an urgent need for strategies to improve glycemic control and reduce morbidity and mortality in T1DM. Long-acting GLP-1s are a promising adjunct to insulin. Our study is the first to demonstrate significant A1C reduction and TIR increase without increased hypoglycemia and DKA risk in 27 T1DM patients on long-acting GLP-1s. Longer prospective studies are warranted. Presentation: No date and time listed

Improvement in Clinical Outcomes and Access to Care With Pharmacist-Led Chronic Care Management Services at a Rural Family Medicine Clinic

Background: Chronic care management (CCM) can significantly impact the management of chronic diseases in rural patient populations. To date, few practice models have addressed its impact on clinical outcomes and access to care in rural practice settings. Objective: Implement a sustainable pharmacist-led CCM practice model while tracking clinical outcomes and healthcare access at a rural, medically underserved family medicine clinic. Methods: This study retrospectively examined data from the clinic’s CCM program from October 2020 through May 2021 and included total clinical encounters at three- and 6-months intervals, as well as changes in clinical outcomes like A1c and systolic blood pressure (SBP) at three- and 6-months intervals. Results: Over an 8-month period, 46 patients were enrolled in pharmacist-led CCM services. Those with a CCM encounter or office visit within 3 months of enrollment showed a mean A1c reduction of 1.07% after 3 months (95% CI −1.70 to −.44, P = .0016), while those with an encounter or office visit within 6 months of enrollment displayed a mean A1c reduction of 1.64% after 6 months (95% CI −2.35 to −.92, P < .001). There was a 73.8% increase in total clinical encounters in the 6 months after CCM enrollment compared to the 6 months preceding it, signifying increased access to care. Conclusion: Patients with CCM encounters or office visits within the first 3-6 months experienced statistically significant reductions in A1c. Moreover, total clinical encounters markedly increased in the 6 months after enrollment, allowing for more frequent engagement between ambulatory pharmacists and traditionally challenging rural patients.

Influence of Literacy, Self-Efficacy, and Social Support on Diabetes-Related Outcomes Following Hospital Discharge.

ObjectiveTo evaluate the relationship between health literacy, social support, and self-efficacy as predictors of change in A1c and readmission among hospitalized patients with type 2 diabetes (T2D).MethodsThis is a secondary analysis of patients with T2D (A1c >8.5%) enrolled in a randomized trial in which health literacy (Newest Vital Sign), social support (Multidimensional Scale of Perceived Social Support), and empowerment (Diabetes Empowerment Scale-Short Form) was assessed at baseline. Multivariable models evaluated whether these concepts were associated with A1c reduction at 12 weeks (absolute change, % with >1% reduction, % reaching individualized target) and readmission (14 and 30 days).ResultsA1c (N=108) decreased >1% in 60%, while individualized A1c target was achieved in 31%. After adjustment for baseline A1c and potential confounders, health literacy was associated with significant reduction in A1c (Estimate −0.21, 95% CI −0.40, −0.01, p=0.041) and >1% decrease in A1c (OR 1.37, 95% CI 1.08, 1.73, p=0.009). However, higher social support was associated with greater adjusted odds of reaching the individualized A1c target (OR 1.63, 95% CI 1.04, 2.55, p=0.32). Both higher empowerment (OR 0.23, 95% CI 0.08, 0.64, p=0.005) and social support (OR 0.57, 95% CI 0.36, 0.91, p=0.018) were associated with fewer readmissions by 14 days, but not 30 days.ConclusionThe study indicates that health literacy and social support may be important predictors of A1c reduction post-discharge among hospitalized patients with T2D. Social support and diabetes self-management skills should be addressed and early follow-up may be critical for avoiding readmissions.Clinical TrialNCT03455985.

The impact of a prolonged lockdown and utilization of diabetes telemedicine on cardiometabolic health in people with diabetes during the COVID-19 outbreak in Saudi Arabia

ObjectiveTo mitigate the spread of COVID-19, Saudi Arabia implemented a nationwide lockdown that lasted for approximately five months. Due to the limited availability of telemedicine in Saudi Arabia, many people with diabetes (PWD) lost access to diabetes care services during the lockdown period. Here, we examined the impact of lockdown on cardiometabolic health in PWD and how this may have differed between those who utilized diabetes telemedicine during lockdown versus those who did not. MethodsHemoglobin A1C (A1C), body weight, lipid, and other cardiometabolic parameters were retrospectively reviewed in 384 PWD who attended routine clinic visits in the pre-lockdown (September 2019 to March 2020) and post-lockdown (Aug to Dec 2020) periods. Changes in cardiometabolic parameters from pre- to post-lockdown were compared across 3 groups according to the type of visit that they had during lockdown (April to July 2020): “no visit” (n = 215), “in-person” visit (n = 44), or “virtual” visit (n = 125). The virtual visits in our institution followed a simplified protocol that utilized technological tools readily available to most PWD and clinicians. ResultsPWD who attended “virtual” visits during lockdown were the youngest and most likely to have type 1 diabetes; followed by those who attended “in-person” visits and those who had “no visit”. A significant reduction in A1C from pre- to post-lockdown periods was noted in PWD who attended a “virtual visit” (9.02 to 8.27%, respectively, p < 0.01) and those who attended an “in-person” visit (9.18 to 8.43%, respectively, p < 0.05) but not in those who had “no visit” (8.75 to 8.57%, p > 0.05). No significant changes were noted in serum glucose, blood pressure, or lipid parameters during the lockdown in any of the groups. ConclusionSimplified telemedicine visits, including real-time audio calls, were as effective as in-person visits in improving glycemic control in PWD during the lockdown period in a country where telemedicine infrastructure was not well-established. Older adults and those with type 2 diabetes were less likely to utilize telemedicine; suggesting a potential risk of digital divide that warrants greater attention in the future.

1020-P: Racial Disparity in Glycemic Outcome during Real-World Use of an Advanced Hybrid Closed-Loop System (AHCL) among Youth with Type 1 Diabetes (T1D)

Background: African-American (AA) youth with T1D consistently have higher A1c than White (W) patients, even when using open-loop insulin pumps. AHCL technology utilizes glucose sensor data to guide automatic adjustments of insulin by the pump to mitigate hyper and hypoglycemia. Potentially AHCL could reduce or eliminate disparity in glycemic outcome. Methods and Results: We performed a chart review of patients using Tandem Control IQ. trained in its use by the manufacturer’s rep and then followed routinely in clinic (n=62) . 9 patients self identified as AA, A1c=9.2%±1; 37 identified as W, A1c=8.23%±1.5. 6 AA patients and 27 W had used AHCL &amp;gt; 60 days and had follow up data. There was statistical and clinically significant reduction in A1c (-1.0%±1.4, p=0.0016) for W patients but not AA. AA patients had higher A1c and sMBG with lower TIU during AHCL use than W patients. (See table below) . Conclusions: Clinically significant disparity in glycemic outcome persists between AA and W youth during real world use of AHCL. Although this initial report has a relatively small number of participants, the glycemic disparity is consistent with many prior studies using older insulin delivery methods. We conclude that AHCL technology by itself may not be sufficient to overcome racial disparity in glycemic outcome. Additional innovations and support may be required for high-risk patients. Disclosure N.J.Christakis: None. S.Chalew: Advisory Panel; Medtronic. Funding National Institutes of Health (U54GM1O4940) National Institutes of Health (1R21DK118643-O1A1)

967-P: Decentralizing Diabetes Specialty Care Improves Glycemic Control

Parkland Health and Hospital System (PHHS) is the Dallas County safety-net health system and serves indigent Dallas County residents. PHHS has primary care clinics (COPCs) located in underserved areas of the county to provide easier access to its residents. The Diabetes Specialty Clinic (DSC) is located next to the Parkland Hospital, but this location can be difficult to access for patients with limited means. We studied the effect of co-locating a diabetes specialty practice (H-DSC) at a community primary care practice (Hatcher Station COPC (HSC)) by comparing the A1c change between the patients managed by primary care providers at HSC alone or by specialists at H-DSC. Table 1 displays the results of this study. The data show that there was a significant reduction in A1c in the HSC patients seen by primary care and H-DSC patients of -0.2% and -0.5% respectively. There is also a significant difference in baseline and final A1cs between both groups that show that H-DSC patients had poorer baseline glycemic control but also greater improvement in glycemic control. H-DSC patients were also being seen by their primary care providers at HSC, and without the co-location of the DSC to H-DSC, many of these patients would not have accessed care at the DSC main location. This suggests that co-locating diabetes specialty services at local, easy-to-access primary care centers at a safety-net health system can improve the glycemic control of patients with diabetes. Disclosure U.Gunasekaran: None.

91-LB: Glycemic and Metabolic Effects of Long-Acting GLP-1 in T1D

GLP-1 receptor agonists were studied as adjunct therapies in T1D. While short-acting GLP-1 agents are not approved for T1D due to concern of increased DKA risk, long-acting GLP-1 medications are commonly prescribed for T1D. Our study aims to evaluate glycemic and metabolic benefits of long-acting GLP-1 therapy in T1D and assess safety concerns. We conducted a retrospective chart review of T1D patients on a long-acting GLP-1 for at least six months. Parameters collected were A1c, 14-day CGM data at each visit, and metabolic data. Data from two years prior to starting GLP-1, and six or more months after starting GLP-1 were included. We identified 54 participants with T1D on a long-acting GLP-1 (Semaglutide, Dulaglutide, long acting Exenatide, Albiglutide) . Mean GLP-1 duration was 23.85 mo ± 15.46. We found a significant increase in time in range, and significant reductions in A1c, time in hyperglycemia, 14-day Blood Glucose SD, DKA hospitalization, and weight after starting a long-acting GLP-1. Time in hypoglycemia decreased non-significantly. Full data can be found in Table 1.As more data emerges on cardiovascular and renal benefits of long acting GLP-1 in type 2 Diabetes, there have been no reported outcomes in T1D. Our study is the first and the only one that demonstrates glycemic and metabolic benefits of this class in T1D, and safety of its use over 1.5-2 years. It represents real life experience. This data needs to be confirmed by prospective studies. Disclosure D. Mohandas: None. C. Gao: None. J. Calma: None. M. Basina: None.

1021-P: Telehealth Benefits among Latinx Adolescents and Young Adults (AYA) with Type 1 Diabetes (T1D)

Background: Historically disadvantaged, ethnically- and racially-diverse AYA experience significantly greater challenges with T1D management when compared to White peers. To address this inequity, the patient-centered CoYoT1 Care model was adapted and implemented at a T1D clinic serving primarily ethnically- and racially-diverse AYA. Methods: In a randomized controlled 2x2 trial, 68 AYA received either CoYoT1 Care or Standard Care via in-person or Telehealth (TH) . Hemoglobin A1c (A1c) and T1D-related distress were measured at baseline and after four quarterly clinic visits, and analyzed via linear mixed models adjusting for age, sex, and attendance. Results: At study end, participants in TH showed reduced A1c (p=0.01) and no changes in physician-related distress (p=0.04) , compared to increased A1c and distress in those randomized to in-person care. Secondary analyses revealed that these TH benefits were attributable to Latinx AYA subgroup. Compared to Latinx participants randomized to in-person care, those in TH showed significant reductions in A1c (p=0.003; Figure) and physician distress (p=0.008) . Among non-Latinx participants, no significant differences in A1c or distress were observed. Conclusion: The TH CoYoT1 Care model engages underserved, ethnically-diverse AYA and leads to improved outcomes. Next steps include collaborating with stakeholders to adapt and implement the model nationwide. Disclosure J.J.Flores garcia: None. M.W.Reid: None. E.Pyatak: Research Support; Abbott Diabetes. J.L.Fogel: None. D.Fox: None. E.Salcedo-rodriguez: None. J.Raymond: None.

4-LB: Remission of Type 2 Diabetes and Improvement in Metabolic Markers with the Twin Precision Treatment Technology (TPT) —A Multicenter, Randomized, Controlled Trial

The study was designed to determine the effect of TPT vs. standard care (SC) on change in A1C and T2DM remission at 90 day intervals, in addition to multiple secondary endpoints. The TPT intervention uses the Whole-Body Digital Twin Platform, with AI and Internet of Things, to integrate multi-dimensional data to give precision nutrition and health recommendations via the TPT app and by coaches. Baseline mean age, diabetes duration and A1C obtained in 319 pts were 45y (±9.7y) , 3.9y (±2.9y) and 9.0% (±1.9%) , respectively. Interim analysis of 262 pts (TPT n=199; SC n=63) who reached 180d showed 94.9% (189/199) of TPT pts had A1C &amp;lt; 6.5%, on no medications or metformin only; 83.9% (167/199) achieved diabetes remission based on ADA criteria. All 9 insulin-using pts stopped insulin before 90d. The Table shows significant improvement in secondary endpoints in TPT pts at baseline and 180d, including A1C (9.0% to 5.7%, P&amp;lt;0.001) . TPT pts had -3.3% change in A1C (95% CI -3.6 to -3%, P=&amp;lt;0.001) compared to SC with -0.39% (95% CI -0.73 to -0.043%, P=0.028) , with a significant between-group difference (P=&amp;lt;0.0001) . The TPT intervention in pts with T2DM allowed for significant reduction in A1C, diabetes remission (∼84%) and improvement in multiple metabolic parameters at 6 months. Future long-term studies are needed to support these initial findings. Disclosure P. Shamanna: None. M. Thajudeen: None. A. Keshavamurthy: None. F. R. Kaufman: Consultant; Twin Health, Employee; Senseonics. S. R. Joshi: Advisory Panel; AstraZeneca, Consultant; Biocon, Franco India, Glenmark Pharmaceuticals, Marico, Sanofi, Twinhealth, Zydus Cadila, Speaker’s Bureau; Abbott, Serdia Pharmaceuticals (India) Pvt. Ltd. L. Shah: None. J. Mohammed: None. M. Mohamed: None. T. Poon: None. M. Dharmalingam: None. B. Saboo: None. S. Damodharan: None. A. Vadavi: None.

71-LB: Real-World Evidence of Arabic Digital Therapeutics for People Living with Type 2 Diabetes in Qatar

Background: Around 17% of people in Qatar live with diabetes. This study reports on the impact of an Arabic digital therapeutics product, named Droobi Health™ (DH) on glycemic control in patients with T2DM. Methods: DH provides participant with a 16-week digital behavior change program tailored for people with T2DM. The programs are based on DSME content and AADE7 guidelines for T2DM, with the content localized to be culturally relevant. The DH app gives participants access to chat with a real-human CDE, tracking tools for blood glucose, weight, food intake, and physical activity, and weekly lessons. Participants at primary healthcare centers with T2DM and a starting A1c equal to or greater than 8% were provided the DH intervention. A post-intervention A1C was measured after three months. This study presents results from 633 participants who completed follow-up A1c. Results: The mean pre and post-intervention A1c for 633 participants was 9.67% and 8.76% respectively, showing a mean reduction of 0.91% (95% CI 0.73%-1.09%, P≤0.001) . For women, the use of DH was associated with a statistically significant A1c reduction of 0.73% (95% CI 0.42%-1.04%, P≤0.001) . For men, the use of DH was associated with a statistically significant A1c reduction of 0.99% (95% CI 0.75%-1.21%, P≤0.001) . Conclusion: Based on the results, participants have improved glycemic control outcomes, particularly male participants, underscoring DH’s potential to deliver a clinically effective intervention for people with T2DM in Qatar and across the Middle East. Disclosure N. Jandali: Stock/Shareholder; Droobi LLC. R. Saad: Employee; Droobi LLC.